Tessier et al. 2025 — Optimal Dietary Patterns for Healthy Aging
Source: Tessier, A.-J., Wang, F., Ardisson Korat, A., Eliassen, A. H., Chavarro, J., Grodstein, F., Li, J., Liang, L., Willett, W. C., Sun, Q., Stampfer, M. J., Hu, F. B., & Guasch-Ferré, M. (2025). Optimal dietary patterns for healthy aging. Nature Medicine. https://doi.org/10.1038/s41591-025-03570-5
Published: 2026-03-23 | Journal: Nature Medicine | Cohorts: nurses-health-study (1986–2016), health-professionals-follow-up-study (1986–2016)
What It Studied
A 30-year prospective cohort analysis of 105,015 US adults (70,091 women / 34,924 men) examining how adherence to eight named dietary patterns and ultraprocessed food (UPF) consumption predicts a composite healthy-aging outcome. The outcome required surviving to age 70 free of 11 major chronic diseases, with intact cognitive, physical, and mental health.
Only 9.3% of participants achieved healthy aging over 30 years — a sobering baseline showing most aging is not “healthy” by these criteria.
The Eight Dietary Patterns
| Pattern | Focus | Score Range |
|---|---|---|
| AHEI | Chronic disease prevention (11 components) | 0–110 |
| aMED | Mediterranean staples (9 components) | 0–9 |
| DASH | Hypertension prevention (8 components) | 8–40 |
| MIND | Brain health (15 components) | 0–15 |
| hPDI | Healthy plant-based foods | 18–90 |
| PHDI | Planetary Health Diet (EAT-Lancet) | 0–140 |
| rEDIH | Low insulin-stimulating diet (reversed) | — |
| rEDIP | Low inflammatory diet (reversed) | — |
Key Findings
All Dietary Patterns Worked — But AHEI Led
All eight patterns significantly associated with healthy aging. Odds ratios (highest vs lowest quintile):
- AHEI: OR 1.86 (95% CI 1.71–2.01) — strongest overall
- rEDIH: OR ~1.7 — second strongest
- aMED, DASH, PHDI — similar mid-range associations
- hPDI (healthy plant-based): OR 1.45 — weakest, likely because it doesn’t penalise unhealthy plant foods
Shifting the age threshold to 75 years, AHEI’s association strengthened further (OR 2.24, 95% CI 2.01–2.50).
Domain-Specific Leaders
| Healthy Aging Domain | Strongest Pattern |
|---|---|
| Physical function | AHEI (OR 2.30) |
| Mental health | AHEI (OR 2.03) |
| Cognitive function | PHDI (OR 1.65) |
| Free of chronic diseases | rEDIH (OR 1.75) |
| Surviving to age 70 | PHDI (OR 2.17) |
Beneficial Foods (Across All Patterns)
- Fruits, vegetables, whole grains
- Unsaturated fats (especially polyunsaturated), nuts, legumes
- Low-fat dairy products
- Added unsaturated fat particularly associated with surviving to 70 and physical/cognitive function
Harmful Foods (Across All Patterns)
- Trans fats and sodium: consistently negative across all domains
- Red and processed meats, total meat: inversely associated
- Sugary beverages: negative
- Liquor: negative (though moderate wine/alcohol varied by pattern)
Ultraprocessed Foods
Higher UPF consumption predicted 32% lower odds of healthy aging (OR 0.68, 95% CI 0.63–0.73), with consistent negative associations across all five individual healthy-aging domains.
Subgroup Effects
- Associations were stronger in women than men (P interaction < 0.0001 for most patterns)
- Stronger in smokers and those with higher BMI — suggesting diet especially matters when other risk factors are present
- Stronger in those with below-median physical activity — diet and exercise appear to be partially substitutable
Methods Highlights
- Data: nurses-health-study + health-professionals-follow-up-study — n = 105,015
- Dietary assessment: Validated food-frequency questionnaire (130+ items), repeated every 4 years from 1986–2010
- Long-term exposure: Average dietary pattern score over 1986–2010 (24 years of diet data)
- Outcome window: 2016 assessment (30 years from baseline)
- Key strength: Repeated diet measurements over decades plus a multidimensional aging outcome; controls for BMI, physical activity, smoking, SES, ancestry
- Key limitation: Health professionals cohort limits generalisability; cognitive/physical function self-reported; reverse causation cannot be fully excluded
Key Concepts Referenced
- healthy-aging | alternative-healthy-eating-index | mediterranean-diet | dash-diet | mind-diet | ultraprocessed-foods | anti-inflammatory-diet | dietary-patterns
- nurses-health-study | health-professionals-follow-up-study | harvard-chan-school | walter-willett | frank-hu
Takeaways for Practical Application
- AHEI is the single best-validated pattern for overall healthy aging across both sexes and cohorts.
- All healthy patterns share a common core: more plants, less processed meat, less sodium and trans fat.
- Ultraprocessed foods are the clearest harm signal — 32% reduction in healthy aging odds is substantial.
- No single magic food — it’s the overall pattern that matters; individual “superfoods” won’t compensate for a poor overall diet.
- The hPDI (strictly plant-based) underperformed AHEI/Mediterranean, likely because it lacks dose-response for healthy vs. unhealthy plant foods.